Based on review of facility policy, interview, observation, and record review, the facility failed to report the elopement of Resident (R)13 to the required community agencies. Specifically, on 01/15/26 at approximately 2:30 PM, R13 had a successful, unwitnessed elopement from the facility. The facility failed to report the elopement to the State Survey Agency as required. On 01/22/26 at 11:57 AM, it was determined that the facility's non-compliance with one or more federal health, safety, and or quality regulations has caused or was likely to cause serious injury, serious harm, serious impairment, or death.On 01/22/26 at 11:57 AM, the survey team provided the Administrator with a copy of the CMS Immediate Jeopardy (IJ) Template and informed the facility IJ existed as of 01/15/26 when the… …
F609 citations in South Carolina
Reporting alleged violations · Freedom from Abuse, Neglect, and Exploitation Deficiencies
Timely report suspected abuse, neglect, or theft and report the results of the investigation to proper authorities.
Data as of , released by CMS on October 8, 2026. Source: CMS Provider Data Catalog.
Against expectation — 2025
South Carolina cites F609 more often than its own record predicts
1.31 times the share F609 takes of citations nationally.
Of every deficiency written in South Carolina in 2025, this is the portion that was F609.
Each state is measured against its own expected share, not against other states.
In the surveyor’s words
What South Carolina surveyors wrote
F609 findings written in South Carolina, one from each severity band recorded here, most serious first.
Severity is as the surveyor wrote it. Some findings had already been corrected before the survey.
Based on review of facility files and interview, the facility failed to ensure that all alleged violations involving neglect are reported immediately, but not later than 2 hours after the allegation is made, if the events that cause the allegation involve abuse or result in serious bodily injury, to the State Survey Agency. Certified Nurse Aide (CNA) #1 was noted to neglect Resident #1 by transferring the resident without assistance per the resident's plan of care. Resident #1 fell during the transfer and sustained a femur fracture. One of three residents reviewed for neglect. The findings included: The Surveyor requested to see all reportable incidents upon entering the facility on 11/29/18. …
Based on interview, record review, and facility policy review, the facility failed to ensure an allegation of staff-to-resident abuse was reported to the State Agency within two hours of the allegation being made for one of one resident (Resident (R) 118) reviewed for abuse reporting of 44 sample residents. This failure had the potential to prevent other resident incidents from being reported timely to the administrator and to the state agency. Findings include: Review of the facility's policy titled, Leadership Policies and Procedures III: Organizational Ethics Subject: Abuse, Neglect, Exploitation, or Mistreatment revealed Policy: .2. …
The short window
Recent years
| Year | Share of South Carolina citations | vs expected |
|---|---|---|
| 2023 | 1.42% | 0.72× |
| 2024 | 3.23% | 1.42× |
| 2025 | 3.19% | 1.31× |
Shares of citations, not counts: earlier years hold fewer inspections.
What else South Carolina surveyors cite →
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